Scarring case study - right upper limb and left lower limb

The aim of this case study is to illustrate that an assessment of scarring should provide a clear description of the scar/s that in turn supports an assessment with reference to all 5 of the TEMSKI criteria and all 10 of the TEMSKI descriptors. Reasoning related to the assessment of multiple scarring must also be included.

Motor Accident Details

39 year old driver of a small car which collided with a four-wheel drive. Assessment 2 years post motor accident. Clinical appearance of mature scars. No further treatment planned.

Injuries:

Laceration right forearm

Closed comminuted fracture left patella

Scattered lacerations

Surgery:

Debridement and repair laceration right arm and left hand

Repair partially divided tendon left extensor carpi ulnaris tendon

Open reduction and internal fixation left fractured patella

Subsequent removal of internal fixation from his left knee.

Description:

Right arm: Fine, soft, flat, mobile scar, 10 cms long x 3 cms wide, on the posterior aspect of the proximal end of right forearm; no stitch marks; very minor contour deformity; small muscle hernia visible and slightly raised above the level of surrounding skin beneath the scar. No effect on ADLs; no treatment required.

Left hand: small scar, 5 cms long, ulnar side of the dorsum of left hand; majority of scar fine, radial end of scar widened and measured 1.0cms x 0.8 cms; scar soft and mobile; slightly hyperpigmented; no stitch marks; no contour deformity. No effect on ADLs; no treatment required.

Left Knee: prominent, longitudinal scar, 15 cms long and up to 1.4 cms wide over patella of left knee; scar soft, flat and mobile; hyperpigmented; no stitch marks; no contour deformity. Unable to tolerate prolonged kneeling which impacted ADLs in relation to cleaning and gardening; no treatment is required.

Assessment:

Conscious of the scarring;

Noticeable colour contrast of the scarring with surrounding skin;

Easily able to locate scars;

Minimal trophic changes:

Stitch marks barely visible:

Anatomical location visible:

Very minor contour defect as a result of the small muscle hernia:

Minor limitation of a few ADLs in relation to the left knee:

No treatment required; &

No adherence.

Determination:

Overall the 3 scars best fit is in the 1% - 2% WPI range.

Reasoning:

Several factors warrant the allocation of 2% WPI. The total effect of the scars on the organ system as a whole has taken account of: the multiplicity of the scars; the visibility of all 3 scars; the minor contour defect; and, there is a minor limitation in the performance of some ADLs.

Note: The photos provide an indication of the types of scars. Some defects, such as contour defect are not clearly visible.